比较依前列醇、肝素和柠檬酸盐在接受连续肾脏替代治疗的儿童中的抗凝疗效和安全性。
A Comparison of the Anticoagulation Efficacy and Safety of Epoprostenol to Heparin and Citrate in Children Receiving Continuous Renal Replacement Therapy.
机构信息
Division of Pediatric Critical Care, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA.
Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA.
出版信息
Blood Purif. 2024;53(10):838-846. doi: 10.1159/000540302. Epub 2024 Jul 18.
INTRODUCTION
Anticoagulants are used in continuous renal replacement therapy (CRRT) to prolong filter life. There are no prior investigations directly comparing epoprostenol to more commonly used forms of anticoagulation in children. Therefore, the primary aim of this study was to assess the efficacy and safety of epoprostenol as compared to heparin and citrate anticoagulation in a pediatric cohort.
METHODS
We performed a retrospective analysis of all patients <18 years of age admitted to an academic quaternary care children's hospital from 2017-2022 who received epoprostenol, heparin, or citrate exclusively for CRRT anticoagulation. Efficacy was evaluated by comparing the hours to the first unintended filter change and the ratio of filters used to CRRT days. Safety was assessed by evaluating changes in platelet count and vasoactive-ionotropic score (VIS).
RESULTS
Of 101 patients, 44 received epoprostenol (43.6%), 38 received heparin (37.6%), and 19 received citrate (18.8%). The first filter change was more commonly planned in patients receiving anticoagulation with epoprostenol (43%) as compared to citrate (11%) or heparin (29%) (p = 0.034). Of those patients where the first filter change was unintended (n = 33), there were greater median hours until the filter was replaced in those receiving epoprostenol (29) when compared to citrate (21) (p = 0.002) or heparin (18) (p = 0.003). There was a smaller median ratio of filters used to days on therapy in the patients that received epoprostenol (0.53) when compared to citrate (1) (p = 0.003) or heparin (0.75) (p = 0.001). For those receiving epoprostenol, there was no significant decrease in platelet count when comparing values prior to CRRT initiation through 7 days of therapy. There was no significant difference in VIS when comparing values prior to CRRT initiation through the first 2 days of CRRT.
CONCLUSIONS
Epoprostenol-based anticoagulation is effective when compared to other anticoagulation strategies used in pediatric CRRT with a favorable side effect profile.
简介
抗凝剂用于连续肾脏替代治疗（CRRT）以延长滤器寿命。目前尚无直接比较前列环素与儿童中更常用的抗凝形式的研究。因此，本研究的主要目的是评估前列环素与肝素和柠檬酸盐抗凝在儿科患者中的疗效和安全性。
方法
我们对 2017 年至 2022 年期间在一家学术四级儿童医院接受单纯 CRRT 抗凝的所有年龄<18 岁的患者进行了回顾性分析，患者接受前列环素、肝素或柠檬酸盐抗凝。通过比较首次非计划性滤器更换的时间和滤器与 CRRT 天数的比值来评估疗效。通过评估血小板计数和血管活性-离子otropic 评分（VIS）的变化来评估安全性。
结果
101 例患者中，44 例接受前列环素（43.6%），38 例接受肝素（37.6%），19 例接受柠檬酸盐（18.8%）。与柠檬酸盐（11%）或肝素（29%）相比，接受前列环素抗凝的患者中更常计划首次滤器更换（43%）（p = 0.034）。在首次滤器更换为非计划性的患者中（n = 33），接受前列环素治疗的患者中位至更换滤器的时间更长（29 小时），而接受柠檬酸盐（21 小时）或肝素（18 小时）的患者（p = 0.002）或肝素（p = 0.003）。接受前列环素治疗的患者中位治疗天数与滤器使用比例较小（0.53），而接受柠檬酸盐（1）或肝素（0.75）治疗的患者（p = 0.003）。对于接受前列环素治疗的患者，与 CRRT 开始前相比，血小板计数在 CRRT 开始前至治疗 7 天期间没有显著下降。与 CRRT 开始前相比，在 CRRT 开始后的前 2 天内，VIS 值没有显著差异。
结论
与儿科 CRRT 中使用的其他抗凝策略相比，前列环素抗凝有效，且具有良好的副作用谱。
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